Healthcare Provider Details

I. General information

NPI: 1588001242
Provider Name (Legal Business Name): TREY LENNIS CECIL OXFORD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR STE 180
NAMPA ID
83687-7912
US

IV. Provider business mailing address

9850 W ST LUKES DR STE 180
NAMPA ID
83687-7912
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-1680
  • Fax:
Mailing address:
  • Phone: 208-322-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM-15745
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: